Ann Coloproctol.  2019 Jun;35(3):137-143. 10.3393/ac.2018.09.28.

Oncologic Outcomes of Postoperative Chemoradiotherapy Versus Chemotherapy Alone in Stage II and III Upper Rectal Cancer

• Yoon JE
• Lee SY
• Kwak HD
• Yeom SS
• Kim CH
• Joo JK
• Kim HR
• Kim YJ

• KMID: 2453249
• DOI: http://doi.org/10.3393/ac.2018.09.28

Abstract

PURPOSE
The aim of this study was to assess oncological outcomes of postoperative radiotherapy plus chemotherapy (CRT) versus chemotherapy alone (CTx) in stage II or III upper rectal cancer patients who underwent curative surgery.
METHODS
We retrospectively reviewed 263 consecutive patients with pathologic stage II or III upper rectal cancer who underwent primary curative resection with postoperative CRT or CTx from January 2008 to December 2014 at Chonnam National University Hwasun Hospital. Multivariate and propensity score matching analyses were used to reduce selection bias.
RESULTS
Median follow-up was 48.1 months for the entire cohort and 53.5 months for the matched cohort. In subgroup analysis of the propensity score matched cohort, the 3-year local recurrence-free survival was 94.1% (95% confidence interval [CI], 87.8%-100%) in the CRT group and 90.1% (95% CI, 82.8%-97.9%) in the CTx group (P = 0.370). No significant difference in disease-free survival was observed according to treatment type. On multivariate analysis, circumferential resection margin involvement (hazard ratio [HR], 2.386; 95% CI, 1.190-7.599; P = 0.032), N stage (HR, 6.262; 95% CI, 1.843-21.278, P = 0.003), and T stage (HR, 5.896, 95% CI, 1.298-6.780, P = 0.021) were identified as independent risk factors for local recurrence of tumors of the upper rectum.
CONCLUSION
Omission of radiotherapy in an adjuvant treatment setting may not jeopardize oncologic outcomes in stages II and III upper rectal cancer.

Keyword

Rectal neoplasms; Recurrence; Chemoradiotherapy; Drug therapy

MeSH Terms

Chemoradiotherapy*
Cohort Studies
Disease-Free Survival
Drug Therapy*
Follow-Up Studies
Humans
Jeollanam-do
Multivariate Analysis
Propensity Score
Radiotherapy
Rectal Neoplasms*
Rectum
Recurrence
Retrospective Studies
Risk Factors
Selection Bias